Survival benefit associated
with low-level physical activity

"The direct health benefits of exercise are irrefutable. Exercise can reduce cardiovascular mortality and, in particular, coronary mortality by many mechanisms, including improvement in endothelial function, autonomic tone, inflammation, and risk-factor control."

In the Lancet, Chi Pang Wen and colleagues¹ report their findings from a very large observational study, showing that a small amount of leisure-time physical activity reduces total mortality, mortality from cardiovascular disease, and mortality from cancer. Although the ability of physical activity in moderate amounts to reduce mortality from all causes has been well documented, ^2-4 the public-health recommendation in most countries is to do the equivalent of at least 30 min per day of walking, most days of the week -ie, 150 min per week. ^5,6 Wen and colleagues' study shows that half this amount of physical activity (15 min per day for 6 days a week) reduces all-cause mortality by 14%, cancer mortality by 10%, and mortality from cardiovascular disease by 20%. To our knowledge, this is the first observational study of this size to report important and global health benefits at such a low volume of leisure-time physical activity with this degree of precision. The benefits of physical activity follow a dose-response curve (figure), which clearly shows that although a little amount of physical activity is good, more is better. In an ideal world, people would benefit greatly from 200 min of moderate-intensity physical activity per week, but data from most countries show that this amount of physical activity is achieved by only a small proportion o the population. ^{5, 7} The reason for this reality is multi factorial and complex, and individual, psychosocial, and environmental factors all play a part. ⁸ Repeated, simple advice from a physician - as Wen and colleagues suggest - is one of many interventions that can effectively contribute to increased physical activity. ⁹ We agree that this advise is very simple and probably easily achievable.

Because of its observational nature, Wen and colleagues' study cannot establish causality, but their results are entirely consistent with the findings of prospective randomized trials in secondary cardiovascular prevention that show a clear mortality benefit from regular exercise. ^{10, 11} As such, the direct health benefits of exercise are irrefutable. Exercise can reduce cardiovascular mortality and, in particular, coronary mortality by many mechanisms, including improvements in endothelial function, autonomic tone, inflammation, and risk-factor control. The final common pathways of cardiovascular risk reduction presumably operate through both improved endothelial function and improved autonomic regulation of cardiovascular function. ¹²  Improved endothelial function leads to the prevention and stabilization of coronary atherosclerosis, thereby reducing the risk of acute coronary syndromes. Improved autonomic function leads to a reduced risk of sudden cardiac death. Cancer, like coronary heart disease, is also to an extent preventable and shares several common risk factors such as poor nutrition, obesity, inflammation, and physical inactivity. Therefore, improvements in some of these risk factors with regular exercise could plausibly explain the cancer mortality benefits recorded by Wen and colleagues. The onco protective effects of exercise are certainly an expanding topic of research in cancer. ¹³ 

Finally, noteworthy from a public health perspective, 54% of individuals in the Taiwanese cohort studied were inactive, with another 22% doing low levels of leisure-time physical activity only. Rural-to-urban migration across the Asia-Pacific region through rapid economic growth and industrialization during the past few decades could explain these low levels of physical activity and the concomitant epidemics of obesity and diabetes that are being witnessed^. 14   The knowledge that as little as 15 min per day of exercise on most days of  the week can substantially reduce an individual's risk of dying could encourage many more individuals to incorporate a small amount of physical activity in to their busy lives. Governments and health professionals both have major roles to play to spread this good news story and convince people of the importance of being at least minimally active.

References:

*Anil Nigam, Martin Juneau Montreal Heart Institute and Universite de Montreal 5000 Belanger Street, Montreal Quebec H1T 1C8, Canada anil.nigam@icm-mhi.org
We declare we have no conflicts of interest.
1. Wen CP, Wai JPM, Tsai MK, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet 2011; published online Aug 16, DOI:10.1016/SO140-6736(11)60749-6.
2. Physical Activity guidelines advisory committee. Physical activity guidelines advisory committee report 2008. http://www.health.gov/paguidelines/committeereport (accessed May 12, 2009).
3. Haskell WL. JB Wolff e Memorial Lecture: health consequences of physical activity-understanding and challenges regarding doseresponse. Med Sci Sports Exerc 1994; 26: 649-60.
4. US Department of Health and Human Services. Physical activity and health: a report from the Surgeon General. Atlanta, USA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National center for Chronic Disease Prevention and Health Promotion, 1996.
5. US Department of Health and Human Services.  2008 physical activity guidelines for Americans. http://www.health.gov/paguidelines (accessed May 12, 2009).
6. WHO. Global recommendations of physical activity for health, http://www.who.int/dietphysicalactivity/factsheet_recommendations/ en (accessed Oct. 10, 2010).
7.  Bauman A, Schoeppe S, Lewicka M, et al. Review of best practices in interventions to promote physical activity in developing countries: background document for the WHO workshop on physical activity and public health. 2005. http://www.who.int.dietphysicalactivity/bestpracticePA2008.pdf  (accessed Nov 9, 2010).
8. Pan SY, Cameron C, Desmeules M, Morrison H, Craig CL, Jiang X. Individual, social, environmental, and physical environmental correlates with physical activity among Canadians; a cross-sectional study. BMC Public Health 2009; 9: 21.
9. Grades G, Sanchez A, Sanchez-Pinilla RO, et al, for PEPAF Group. Effectiveness of physical activity advise and prescription by physicians in routine primary care: a cluster randomized trial. Arch Intern Med 2009; 169: 694-701.
10. Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004: 116: 682-92.
11. Jolliff e JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2001; 1: CD001800.
12. Juneau M, Nigam A. Exercise training after an acute coronary syndrome. In: Theroux P ed. Acute coronary syndrome. A companion to Braunwald's heart disease, 2nd edition. Philadelphia: Saunders Elsevier, 2010.
13. Newton RU, Galvao DA. Exercise in prevention and management of cancer. Curr Treat Options Oncol 2008; 9; 135-46.
14. Inoue S, Zimmet P. The Asia-Pacific perspective: redefining obesity and its treatment. 2000. http://www.wpro.who.int/internet/resources.ashz/NUT/Redeining+obesity.pdf  (accessed June 12, 2011).

With all being said in the above article about exericse, HTE believes the Chi Machine is the tool to help us get those 15 minutes per day of physical activity.  Did you know that 15 minutes of using the Chi Machine is estimated to be equivalent to walking ten thousand paces, about 90 minutes of walking in terms of body oxygenation?  If used with the proven relaxation techniques, there it no limit to the potential scope of healing and fitness enhancement for the body and mind.  The Chi Machine will help eliminate body toxins and provide the essential benefits of sporting and fitness programmes without putting stress on the body such as vertebrae, joints, heart and lungs.

Because the "exercise" massage is done in the lying down, relaxed position, with all loads and stress reduced on the spine and other body area during maximum oxygenation  and subsequent energy products, the send of well-being arising form the massage is immediate and noticeable.

Therefore, the chi machine proves a "workout" for the whole body, regardless of sex, age, time of use, place or climate conditions. The simplicity of use and portability of the massager, offers a convenient way for busy people to cultivate a vital exercise habit, which we all need in our lives.